When you ask three hydration experts why people should drink water, what advice do they
give? By Harold Goldstein, DrPH; Stavros A. Kavouras, PhD; and Jodi D. Stookey, PhD

CPO QUIZ..........................................................34

14 | How Much Water Should You Drink?
Global recommendations on water intake vary. Where does recent research stand?
By Roselyne Y. Wagner, PhD, and Isabelle Guelinckx, PhD

20 | Drink More Water Each Day to Optimize
Mood and Mental Tasks (Part I of II)
If you want to optimize your mood and cognitive processes, science shows why you should
drink water daily. By Lawrence E. Armstrong, PhD

24 | The National Drinking Water Alliance:
Who We Are, What We Do, and Why You Should Care
Water is the business of IBWA members, but it’s also the business of the National
Drinking Water Alliance. How can we work together to promote water as an essential
part of a healthy diet? By Christina Hecht, PhD

BOTTLED WATER REPORTER, Volume 57, Number 1.
Published six times a year by The Goetz Printing
Company, 7939 Angus Court, Springfield, VA, 22153,
for the International Bottled Water Association, 1700
Diagonal Road, Suite 650, Alexandria, VA 22314-2973.
Tel: 703.683.5213, Fax: 703.683.4074,
www.bottledwater.org.
Subscription rate for members is $25 per year, which is
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rate is $100 per year. Single copies are $7. POSTMASTER:
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IBWA
IBWA

International Bottled Water Association

CHAIRWOMAN’S COMMENTARY

WE JUST CAN’T LIVE
WITHOUT IT!
I’ve often said that you can live without many things in your life, but
you can’t live without water—bottled or not.
As we pursue our busy daily schedules, having a convenient bottle of water should be a
constant for all of us for many reasons. For starts, two-thirds of our bodies are water.
Studies have shown that drinking water can be helpful with losing weight. Drinking
water before a meal may allow you to eat less because you feel full from drinking the
water. Research has also demonstrated that water may help to lubricate our joints by
keeping the cartilage that surrounds our joints healthy.
Many years ago, I attended a talk on a college campus given by a famous comedian.
He lectured the students about not drinking enough water and on how dehydration
was robbing them of their ability to remain alert in class and focus on their studies. He
referenced studies on college students who were required to concentrate for extended
periods of time and, in the absence of drinking water before the task, were found to be
unable to maintain their attention spans.
We also know that drinking water helps our bodies with elimination and can help to
prevent constipation. Water also helps our kidneys and liver by flushing waste products from our bodies.
While all the above is helpful information, we simply need to remember that drinking
water is good for you! Sitting at your office desk during the day, watching your favorite
television show in the evening, enjoying a great meal with family and friends, working
out in your home or local gym—these are all fantastic opportunities to have a bottled
water handy. For me, I keep bottled water in my car for my commute to and from the
office in the Atlanta traffic.

We must not overlook the diligent work of IBWA members and staff to get a “drop”
of a mention (pun intended) about the importance of water consumption in the
2015-2020 Dietary Guidelines for Americans! IBWA focused on increasing the water
messages in the guidelines, and the Dietary Guidelines for Americans now include a recommendation to limit the consumption of sugar-sweetened beverages and drink water.
Also, because of the work of IBWA members and staff, the recommendation—“Drink
water instead of sugary drinks"—now appears on the U.S. Department of Agriculture’s
MyPlateMyWins graphic. See for yourself at bit.ly/MyPlateMyHydrationWins.

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Ethernet-IP). The Q46H/64 is adaptable to any ozone application.

PRESIDENT’S MESSAGE
NEW YEAR, NEW CHANCES
TO PROMOTE
HEALTHY HYDRATION
Consumers are increasingly choosing bottled water as their
packaged beverage of choice.
But what about those who have yet to be persuaded by the health benefits of drinking
water? IBWA staff considered what unanswered questions they might have when
putting together this “Healthy Hydration” issue of Bottled Water Reporter.
We begin by answering the most obvious question: “Why Drink Water?" (p.10).
Here, three noted hydration experts offer their opinions on why people should
make water their primary beverage. We follow that up with “How Much Water
Should You Drink?” (p.14), where Roselyne Y. Wagner, PhD (PMCONSEILS),
and Isabelle Guelinckx, PhD (Danone Nutricia Research), review the varying global
recommendations on water intake—and discuss where current research stands on the
issue. For people who’d like specific examples of how drinking water helps the body,
Drinking Water Research Trustee Lawrence E. Armstrong, PhD, illustrates some of the
documented health benefits of water consumption in his article, “Drink More Water
Each Day to Optimize Mood and Mental Tasks” (p.20).
IBWA is proud of the role we play in helping consumers achieve a healthier lifestyle.
But we know that, if we are going to be successful at promoting healthy hydration for
all, we are going to need allies. In “The National Drinking Water Alliance: Who We
Are, What We Do, and Why You Should Care” (p.24), Christina Hecht, PhD, a senior
policy advisor at the University of California Nutrition Policy Institute, describes the
advocacy work of this influential organization—and outlines some of the ways we can
work together to help ensure, people, especially children, “drink water first for thirst.”
Our columns continue the discussion on how to promote the benefits of water consumption. We first review ways members can fold healthy hydration information into their
conversations with members of Congress in our Government Relations column (p.28).
Next, the Communications column (p.30) emphasizes the importance of recognizing that
the shift of moving from carbonated soft drinks to bottled water is consumer driven—and
Americans have been increasing their consumption of bottled water for decades. The Technical Update column (p.32) veers our focus to the Food Safety Modernization Act’s (FSMA)
Intentional Adulteration Rule and reviews what impact it will have on IBWA bottlers.
A new year introduces new opportunities for IBWA members to work together to
ensure consumers, legislators, and the media know the truth about bottled water and
healthy hydration. We look forward to working on the issues with you in 2017.

The Drinking Water Research Foundation (DWRF) would like to thank all
of the sponsors that helped its Casino Night Fundraiser be a success.
This wonderful event, held at B.B. Kings in Nashville, Tennessee, on
November 8, 2016, could not have happened without the support of DWRF
sponsors and guests. All money raised during the 2016 fundraiser will help
fund vital research impacting the future of the bottled water industry.
TO LEARN MORE ABOUT DWRF, VISIT WWW.THEFACTSABOUTWATER.ORG.
NOV/DEC 2016

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WATER NOTES

SCIENCE

Research Suggests Pregnant Women Should
Not Be Concerned About BPA
In a Science 2.0 article,
Steve Hentges, PhD, with the
American Chemistry Council
(ACC), analyzes a 2016 study
by French researchers (bit.ly/
FrStudyBPA) on the exposure of pregnant women to
more than 100 substances
that may be of concern to
a developing fetus, including bisphenol A (BPA). The
French study found through
urine biomonitoring that the
majority of women were
exposed to BPA, but the
study did not address if the
exposure levels were safe.
However, the median BPA
level reported, .75 micrograms/liter, is comparable
to results from a large-scale
study of pregnant women in
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Canada and biomonitoring
studies in the United Sates.
The levels of BPA found in the
French study are low when
compared to the levels of
metals and organic chemicals
reported in those studies.
Hentges used both
exposure data and health
effects discovered via a
safety or risk assessment to
evaluate the safety of BPA.
Health effect information
describes what “effects can
be caused by exposure” to
a particular substance—and
“at what exposure level the
health effects might occur.”
Exposure information is
used to ascertain whether
these exposures are above
or below critical levels.

The safety risk assessment used was from a
group of Greek scientists
who released in late 2016
a peer-reviewed scientific
assessment on BPA (bit.ly/
GrkStudyBPA) and concluded that “exposure to BPA
does not pose any significant
threat according to most
realistic exposure scenarios.”
Their conclusion is relevant
because the Greek study
“explicitly included pregnant
women.” Their findings are
consistent with the conclusions reached by government bodies throughout the
world on the safety of BPA.
The Greek study calculated a biomonitoring
equivalent (BE) based on

the conservative safe intake
level for BPA established
by the European Food
Safety Authority (EFSA).
The BE level represents the
estimated concentration of
BPA in urine corresponding
to BPA at the safe intake
level. Applying the BE to the
median BPA exposure level
in the French study shows
the level of exposure is more
than 400 times below the
BE level. As Hentges notes,
that indicates that “not only
are the actual French exposure levels safe, but they’re
safe with a wide margin of
safety.” The Greek scientists
also stated “there is no reason for concern based on
either individual or aggregate
scenarios of BPA exposure.”
Another important aspect
of the French study is that
the urine was monitored for
both “unconjugated” and “total” BPA. Unconjugated BPA
is BPA itself. It was found at
low levels in only 10 percent
of the urine samples. Total
BPA is a metabolized form
of BPA, and it was found in
about 74 percent of the urine
samples, confirming this
important metabolic process
occurred in the French
pregnant women. Hentges
concludes that “since the
metabolite is biologically inactive and rapidly eliminated
from the body, BPA is not
likely to cause health effects
at the low exposure levels
measured in the study.”
For more details, read
"Should Pregnant Women
Be Concerned About BPA?"
at bit.ly/Science20BPA.

WATER NOTES
CONFERENCE AND TRADE SHOW

IBWA Announces 2016
Award Winners
During the 2016 IBWA Annual Business Conference and Trade
Show, held November 7-11 in Nashville, Tennessee, the association announced the winners of eight prestigious awards.
IBWA Board Member, and Supplier and Convention Committee Co-Chair, Dan Kelly (Polymer Solutions International) announced winners in the categories of Route Salesperson of the
Year, Plant Manager of the Year (2), Supplier of the Year, Product Innovation, Kristin Safran/IBWA Board of Directors’, and
Shayron Barnes-Selby/IBWA Advocacy (2) awards during the
conference general session, attended by more than 300 IBWA
members and conference attendees. “These winners truly represent excellence within the bottled water industry and IBWA’s
membership,” said IBWA President Joseph Doss.
For many years, IBWA has held an awards program to
recognize the contributions and achievements of bottled
water professionals. It is important to IBWA members that
the association celebrates and honors these individuals with
a ceremony because we know that it takes an incredible and
dedicated workforce to produce and deliver bottled water
products. IBWA wishes to congratulate all of our 2016 winners
and thank the member companies that participated in the
2016 award program.

“Drink water instead of sugary drinks"—
now appears on the USDA’s MyPlateMyWins graphic. See for yourself at
bit.ly/MyPlateMyHydrationWins.

king for new op
portunities to co
nnect with
educate them
about bottled w
share any of th
ater issues, feel
e following on yo
free to
ur social media
sites during Janu
and February—
ary
or be inspired an
d write your ow
n!

consumers and

New Year, New You! Whatever your New
Year's resolutions, make sure you bring your
#BottledWater along to stay #healthy and
#hydrated in 2017! bit.ly/NewYearNewH2O

But first...water! #H2OfCourse

National Campaigns

www.instagram.com/p/
BOM8CV3gv40/?taken-by=urh2o

January: National Hot Tea Month, New Year's
Day (January 1), National Winter Skin Relief Day
(January 8)
February: American Heart Month, National
Children's Dental Health Month, National Pizza Day
(February 9), Valentine's Day (February 14)
Not feeling thirsty? #Hydration is important no
matter what the temperature is outside. Make
sure you stay properly #hydrated even during the
winter months! bit.ly/WinterH2OHydration

The benefits of drinking #water are
endless! We take #BottledWater with us
everywhere to keep our bodies #healthy
and #hydrated!
www.instagram.com/p/
BODPeqpBpMz/?takenby=bottledwatermatters
Should Pregnant Women Be Concerned About
BPA? Greek scientists have stated that “there
is no reason for concern based on either
individual or aggregate scenarios of BPA exposure.” That conclusion is consistent with the
views of government bodies worldwide.

The holiday season is officially over and
@SelfMagazine has some tips to help you get
back on trace after the festivities. We especially
like #1: "Swap all other beverages for water!"
www.self.com/story/8-sneaky-ways-to-debloatin-just-one-day

Download: bit.ly/WinterH2OHydration

Ways to prevent cavities: Obviously, brush/
floss daily. Next Best Tip? “Drink water or
rinse mouth with water after eating.”
#NationalChildrensDentalMonth
www.pinterest.com/pin/414964553151045877

February is National Heart Month and the American
Heart Association is reminding us that “keeping the
body hydrated helps the heart more easily pump
blood through the blood vessels to the muscles. And,
it helps the muscles work efficiently.” Check out more
tips from the AHA and stay #hydrated! http://www.
heart.org/HEARTORG/HealthyLiving/PhysicalActivity/
FitnessBasics/Staying-Hydrated---Staying-Healthy_
UCM_441180_Article.jsp#.VqeXe4UrK71

Download: bit.ly/HydratedHeart
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Have a happy and #hydrated Valentine's Day!!!
#hearthealthy with bit.ly/HydratedHeart

DYK, proper hydration throughout the
winter months is just as important as
during the warmer months?
bit.ly/WinterH2OHydration

WATER NOTES

ENCOURAGING WATER CONSUMPTION

Drink Up in LA

Last December, the Drink Up Initiative
hosted several events in Los Angeles to
support its recent campaign focused on
encouraging LA citizens to drink more
water. Self Help Graphics and Art in
East LA, one of Drink Up’s community
partners, hosted a successful event.
Other supporters included the American
Beverage Association/Aquafina and
Dasani, the Alliance for a Healthier
Generation, Mayor Eric Garcetti, the LA
Department of Water and Power, Polvora
Advertising (Drink Up’s LA creative
firm), The California Endowment, Brita,
Haws, and many others.
The LA Dodgers, LA Dodgers
Foundation, and the LA Galaxy sent
sports giants from the past and present
to help promote the benefits of water
consumption, including former Dodger

Ron Cey and current LA Galaxy players
Rafael Garcia and AJ DeLaGarza.
Thus far, Drink Up has garnered
nearly 6 million impressions combined
between TV, blogs/local news, and
social media. But, this is only the start

for Drink Up in LA, as planning for
more local—and national—events for
2017 are underway! If you’re interested
in learning more about Drink Up’s LA
campaign, visit h2oclaro.com.

ENVIRONMENTAL STEWARDSHIP

How the Recycling Partnership Works to Increase
PET Packaging Recovery
In 2016, IBWA joined the Recycling Partnership (TRP) as a
funding partner. TRP is an innovative industry collaboration
that is focused on systematically and measurably improving
curbside recycling in the United States. Working with community and industry partners nationwide, TRP identifies bestin-class operational and technical support and proven community outreach approaches to improve curbside recycling
rates. During the 2016 IBWA Annual Business Conference,
TRP Director of Corporate Partnerships Jeff Meyers provided
an overview of the organization’s recent successful projects.
Meyers discussed how TRP is focused on increasing
new PET packaging recovery. Some commonalities among
the highest recovery programs are single stream or fully
comingled recycling, the use of carts, an automatic service,
and local action for recycling. Sixty percent of recyclable
PET packaging is found in the home and still remains
unrecovered at a loss to companies, governments, recyclers,
and the environment. TRP attains measurable change in
curbside recycling by partnering with communities to adopt
best practices through a “boots on the ground” approach—
growing access to recycling, educating consumers, providing

technical assistance, and expanding best practices. TRP is
scaling up to drive nationwide change at the city, regional,
statewide, and federal level.
This approach has generated results for IBWA and other
TRP members. In the past 24 months, TRP has supported
150 communities with $21 million in investments, 390,000
recycling carts, and greater than 2 million households educated on recycling. For example, a citywide conversion to
carts in Greenville, South Carolina, resulted in 35,000 family
homes converted from bins to carts and 3.2 million pounds
of new PET recovered annually.
The Recycling Partnership encourages IBWA members
to participate in new city activations and launches
scheduled for their areas. To learn more about TRP, visit
recyclingpartnership.org.
JAN/FEB 2017

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9

COVER STORY

WHY

DRINK
WATER?

Bottled Water Reporter asked three hydration
experts why people should drink water.
Hereâ&#x20AC;&#x2122;s what they had to say.

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WHAT WE DRINK MATTERS
By Harold Goldstein, DrPH

There’s an old adage that says we all need eight glasses of
fluid each day to stay healthy and hydrated. It’s a pretty
easy rule of thumb. What we don’t always hear is the
importance of what we choose to quench our thirst. Far too
many people are drinking water that’s loaded with sugar—
better known as sodas, sports drinks, flavored waters, sweet
teas, and energy drinks.
The average American drinks 9 teaspoons of added sugar a
day, adding up to 30 pounds of sugar a year. That’s far more
than the American Heart Association’s recommended total
limit of no more than 5 teaspoons of added sugar a day.
What does all that liquid sugar do to our bodies? It’s bad,
very bad, leading to type 2 diabetes, heart attacks, and fatty
liver disease. Drinking one or two bottles of sugar-sweetened
beverages a day increases the risk for getting diabetes by
almost 30%—and triples the risk of dying from a heart attack;
after six months, daily consumption of these sugary beverages
increases liver fat by almost 150%.

"What does liquid
sugar do to our
bodies? It leads to
type 2 diabetes, heart
attacks, and fatty
liver disease."
Pure, fresh-tasting water is calorie free, provides the hydration
that our bodies need, and can even save money. Water is also
an essential tool for maintaining body temperature and healthy
digestion, cushioning our joints, and protecting our internal
organs. Water has even been proven to be a better option than
sports drinks to support physical activity in most cases.
Without a doubt, water is the easy choice—and the best
choice—for good health.
As a public health advocate, I encourage people to drink water
in whatever form that is most convenient and cost-effective
for them. Drinking safe, healthy, refreshing water is infinitely
healthier than drinking water that’s been loaded with sugar.

Harold Goldstein, DrPH, is the
executive director of Public Health
Advocates, a California-based nonprofit
advocacy organization working to improve
health and turn the tide on the nation’s
obesity and diabetes epidemics.

And those slick ads published by soda companies seem to say
that drinking soda is like opening happiness? They forget to
tell you that if you drink all that sugar long enough, you will
also have to start buying vials of insulin to treat your newly
developed diabetes.
Luckily, a new trend is starting to gain traction. Healthy
hydration—with bottled water leading the charge—is helping
to make our eight daily beverage servings work for our health,
not against it.
JAN/FEB 2017

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11

WATER: THE MOST
IMPORTANT NUTRIENT
How water intake improves health
By Stavros A. Kavouras, PhD, FACSM, FECSS

"Kids that drink more
water in school perform
better in cognitive tasks."
United States alone, there are more than 29 million patients
with diabetes and 85 million with pre-diabetes. How is
diabetes related to water intake and hydration? Recent studies indicate that dehydration and low water intake lead to
higher levels of anti-diuretic hormone. A higher level of this
hormone is associated with development of diabetes, heart
disease, and death. High water intake is thought to be associated with better mood and cognitive function. Kids that
drink more water in school perform better in cognitive tasks.

Water is the most abundant molecule in the human body accounting
for 50-60% of its weight. Nevertheless, water is the most overlooked
and under-studied element in Nutrition Science. Did you know that
water is not included in the U.S. Department of Agriculture’s “My
Plate” nutritional guidelines (choosemyplate.gov)? Water was also not
present in neither the 2005 nor the 1992 food guide pyramid. For this
reason, water is considered the “Forgotten Nutrient.”
Water intake and hydration are mainly regulated by thirst and
the kidneys. When we run low on water, we get thirsty and
we drink. When we drink too much, we go to the bathroom
more often to eliminate the extra water. What is important to
understand is that we do not get thirsty until we are dehydrated.
Then, water intake quickly turns off our body's thirst signal, well
before body water is replenished. As a result, many people do
not know that they are chronically under-hydrated because they
are not thirsty. After all, thirst is a survival instinct, but it is not
necessarily a reliable way to gauge optimal hydration for health.
A 2015 study, based on the U.S. National Health and Nutrition Examination Survey, reported that more than 50% of
children are under-hydrated. One-in-four do not drink any
water, and three-in-four children drink at least one serving of a
sugary beverage. What is worrisome is that low water intake is
associated with a variety of health outcomes. Specifically, studies have shown that low water intake is linked to the development of kidney stones, urinary tract infections, and chronic
kidney disease. Probably more important are the findings
in the area of water intake and diabetes. In the Western
world, diabetes is one of the first causes of cardiovascular
diseases, the number one factor for all-cause mortality. In the
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A simple and practical way to assess if you are drinking enough
water is your urine color and number of visits to the bathroom.
Light or clear urine color and more than 6-7 visits to the bathroom
per day are both good indicators of appropriate hydration.

Stavros A. Kavouras, Phd, FACSM,
FECSS, is an associate professor at the
University of Arkansas’ Hydration Science
Lab. Follow him on Twitter:
@DrHydration.

Drinking water can significantly improve public health with
support from collective impact efforts. Collective impact
efforts are important, perhaps even necessary, for creating
conditions that favor drinking water effects. Depending on
background conditions, drinking water can have negative,
null, or beneficial effects on health. In the case of weight
management, for example, drinking water has had 83 null
effects on body weight outcomes, out of 115 effects, reported
by randomized controlled trials [1]. Background conditions
in these trials did not enable drinking water to lower energy
intake and/or increase fat oxidation. Conditions in New York
City schools, on the other hand, allowed for installation of

WHY DRINK WATER

drinking water stations in cafeterias to significantly reduce the
risk of overweight and obesity for millions of children [2].
Conditions that may modify drinking water effects include
characteristics of the target population at baseline, normal, or
overweight/obese status; ad libitum or restricted diet; amount
and types of beverages consumed; and hydration status (concentrated or dilute urine). Under ad-libitum diet conditions,
interventions to promote drinking water instead of other beverages (i.e., to increase drinking water in relative terms) have been
effective when drinking water replaces all caloric beverages, not
only sugar-sweetened beverages. Under restricted diet conditions, interventions to increase drinking water in absolute terms
have been effective for overweight or obese individuals, if the
volume of drinking water consumed significantly dilutes urine
[below 500 millimoles per kilogram (mmol/kg)].
In New York City schools, the baseline prevalence of overweight
or obesity was 39%, the children had access to ad-libitum
food, and the background availability of caloric beverages was
deliberately limited, such that drinking water replaced caloric
beverages, beyond only sugar-sweetened beverages. Beginning
in 2001, New York City implemented policies to remove soda
from school vending machines, replace whole milk with low-fat
milk in school meals, and limit available beverages to those with
less than 10 calories per 8oz serving. All schools made these
changes before 2009-2010, before installation of drinking water
stations. After installation of the water stations in 2010-2013,
purchases of fat-free chocolate milk decreased significantly [2].
To create and sustain conditions, collective impact partnerships are necessary, such as change in school policy, food supply/vendor contracts, and/or funding streams. Also necessary
is the development of consistent intervention messaging in the
community, tailored to the population characteristics. Alone,
individuals trying to drink water for weight management, or

"Drinking water stations
in New York City school
cafeterias are associated
with significantly
reduced risk of
overweight and obesity
for millions of children."
clinicians advising patients to drink water for weight management, do not have the authority or control over communitywide background conditions.
Null effects of effort to drink water for health outcomes disappoint
individuals who make the effort, leave at-risk individuals at-risk,
breed uncertainty about drinking water effects, and jeopardize community support and sustainability for drinking water efforts.
Industry commitment to, and participation in, collective
impact efforts to create optimal conditions for drinking water
effects may enable communities, around the world, to benefit
from drinking water.

Jodi D Stookey, PhD, is a clinical scientist
at the Childrenâ&#x20AC;&#x2122;s Hospital Oakland
Research Institute.

HOW MUCH
WATER SHOULD
YOU DRINK DAILY?
By Roselyne Y. Wagner, PhD, and Isabelle Guelinckx, PhD

Global recommendations on water intake
vary between health authorities. What is
the scientific evidence behind them?
Water is essential for life. Humans can live for weeks without eating but only a few days
without drinking. Yet, most people are not aware of the existing daily recommendations
for fluid intake. As drinking is so important for health, why aren’t we more aware about
how much we need to drink every day?

We Are What We Drink
The human body is composed of approximately 60% water, depending on age, sex, and
climate conditions [1,2]. Because water is involved in numerous biological functions in
the body—such as building materials for cells and fluids, and temperature control—the
body tightly regulates the amount of total body water. It is constantly balancing water losses
and water gains. Every day, the body loses water through sweat, respiration, fecal losses, and
urine, and it also gains water from metabolic reactions, food, and fluids. (See Figure 1 on p.16.)
Metabolic water production is very limited: it represents, on average, only 300ml. The
largest gain of water is from dietary intake: it’s estimated that approximately 20% of total
water intake comes from food (moisture), and 80% from fluids [2].

Drinking water and all other beverages
(e.g., juices, milk, sweetened/diet/
alcoholic/hot beverages) are considered
as fluids and, within this article, the sum
of all these fluids will be called total
fluid intake. Factors that affect the water
balance are the weather and climate,
clothing, diet, and length and intensity of
physical activity [3,4]. Because the major
source of total body water comes from
fluids, it is important to consider the
amount and the type of fluids you drink.

Total Water Intake
Recommendations:
A History Lesson
The most recent recommendations
concerning water intake in America
were published 12 years ago [1]. There
was limited data on total water intake,
total fluid intake, and/or hydration for
a healthy individual at population level.
That is surprising, considering the
first studies on human hydration were
published in 1950s. In the decades
following up to 2010, the number of
studies increased; however, they were
relevant for specific populations only
(e.g., firefighters or soldiers exposed to
extreme environment conditions) or
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specific conditions (e.g., a patientâ&#x20AC;&#x2122;s management in hospital or physical activity
[6,7]. Moreover, because no links with
the major health complications of the
general population were identified, total
water intake and total fluid intake were
not priority research areas in nutrition.
Researchers tended to focus on energy
intake and nutrients coming from food
rather than those from fluids.
Because in 2014 there was insufficient
scientific evidence indicating that a
certain water intake could reduce the
risk of chronic diseases, the Institute of
Medicine (IOM) based its guidelines
on the median water intake observed in
a national survey [1]. Consequently, the
reference values for total water intake
of adult men and adult women (>19
years) were set at respectively 3.7 liters
per day (L/day) and 2.7 L/day [1].
Knowing that foods contribute for 2030%, the more practical guidelines in the
United States for adults are that men
should drink
3 L/day and women 2.2 L/day [1].
Those reference values were a source
of inspiration for others; China, for
example, used the IOM recommendations as a reference until 2007.

Until recently,
there was limited
data on total
water intake,
total fluid intake,
and/or hydration
for a healthy
individual at
population level.
In the late 2000s, researchers begin to
be interested by hydration biomarkers;
and methods for assessing hydration
emerged [3,8]. In 2010, the European Food Safety Authority (EFSA)
published the European reference
values for total water intake based on
a combination of observed intakes, urine
osmolality values, and energy intake [2].
It was the first recommendation of
water intake that included hydration
biomarkers in its calculation. Currently,
the EFSA guidelines for total water
intake are 2.5L/day for men and 2L/
day for women, meaning that adult men

HOW MUCH WATER

and women should drink respectively
2 L/day and 1.6 L/day. Each European
country is encouraged to include and
adapt those recommendations into their
official national dietary guidelines [2].
Some countriesâ&#x20AC;&#x201D;such as Spain, the
United Kingdom and Turkeyâ&#x20AC;&#x201D;have
already incorporated the recommendations [9-11]; yet, still national dietary
guidelines might benefit from a revision.
For instance, in France the official
dietary guidelines are to drink water ad
libitum (i.e., without restraint or limit),
which could be open to interpretation
by the general public [12].

Emerging Science for
More Specific Water
Recommendations
Adapting an international
recommendation to one country
might be challenging due to the fact
that drinking and eating habits of
individuals are specific to each culture.
When EFSA reviewed the available
data on water/fluid intake in 2010, it
observed great discrepancy in mean
total fluid intake across countries
in Europe [2,13,14]. Ideally, each
country should make an accurate
assessment of total fluid intake in a
sample representative of its population.
Scientists at Danone Nutricia Research
wished to address this gap in the
scientific literature by building and
publishing on the Liq.In7 database.
This database contains information on
the drinking habits of populations in 13
countries across three continents: Japan,
Indonesia, China, Iran, Turkey, Poland,
Germany, United Kingdom, France, Spain,
Argentina, Brazil, and Mexico [15-18].
Besides the cultural aspect, another
possible explanation for the inter-country
differences in mean total fluid intake is
the difference in assessment method used
in the countries. In nutrition research,
the method of assessment is a key point
because people can forget, overestimate,
or underestimate their dietary intake,

Adapting an international
recommendation to one
country might be challenging
due to the fact that drinking
and eating habits of individuals
are specific to each culture.
and such actions, consequently, affect the
accuracy of the data.
The method most widely used for dietary
assessment is "24h dietary recall," which
requests individuals to remember all
food and fluids consumed during the
past 24 hours. A second method used to
assess dietary intake is a diary or record:
individuals record, in real time, over a
period of one or more days, what they
eat and drink. The data present in the
Liq.In database was collected with such
a diary covering seven consecutive days.
The Liq.In record had an additional
special feature: it was specific for fluids. A
comparison of data collected with a 24h
dietary recall versus those collected with
a seven-day fluid record demonstrated
that with a 24h dietary recall, individuals
significantly underestimate about 400ml
of their fluid intake [19]. This potentially
implies that, because the reference values

are based on food surveys and many
food surveys use a 24h recall in their
national surveys, the reference values
for water intake are underestimated.
Because all surveys providing data to the
Liq.In database were performed with the
same record, the results of the different
countries can be compared.
The results of the surveys showed that
in the 13 countries, approximately 60%
of men drank less than 2 L/day and
40% of women less than 1.6 L/day [17].
However, the proportion of adults
with an average fluid intake below the
references ranged from 30% in United
Kingdom to 71% in Japan, showing
again the large difference in drinking
habits between the countries [17].
The Liq.In surveys not only assessed
the amount of fluids but also the type
of fluids consumed. It showed that 25%
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food and beverages to less than 10% of
total energy intake [20]. As described in
the March/April 2016 issue of Bottled
Water Reporter, beverages can contain
up to 9 teaspoons of sugar and should
be consumed accordingly [21,22]. The
Liq.In results showed that 44.5% of
adults exceeded the WHO guidelines
on sugar solely by fluid intake [18,20].

The European
Commission
and the United
States have
both promoted
initiatives to
promote healthy
hydration.

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of the adults drank, on average, less
than 290mL/day of water. In Mexico, Brazil, Argentina, and the United
Kingdom, the adults drank more
sweet beverages than water [18].
This observation was even more
frequently made when investigation
the drinking habits of children and
adolescents. In some countries, up to
52% of what children and adolescent
drink were sugar-sweetened beverages [15]. In 2015, the World Health
Organization (WHO) published
guidelines on sugar intake for adult
and children that recommended reducing the intake of free sugars from

Once the reference values are produced
by the health authorities, they then
need to be translated into practical,
user-friendly tools and tips easily
understood and put into action by
the general population. Visual representations of the dietary guidelines
exist in some countries. For example,
the Chinese Pagoda was developed
by the Chinese Nutrition Society in
2007, recommending at least 1.2 L
of water per day. In 2014, Indonesia
published its pyramid recommending at least 8 glasses of water per day
[23]. (See Figure 2 at left.) Additional
tools can be developed to promote
water. For example, in 2016 the science
service of the European Commission
(EC) published a toolkit to successfully promote healthy hydration at
school [24]. The toolkit indicated that
effective interventions at school had a
multi-component approach combining
education, increased water availability,
and/or parental involvement. Moreover,
the EC highlighted the importance of
engaging the right stakeholders, including the private sector (e.g., water and
soft drinks suppliers) [24]. Another
example of a campaign increasing the
awareness of the importance of healthy
hydration is the extremely popular U.S.
initiative Drink Up, which launched in
2013 to increase water consumption by
encouraging Americans to “drink more
water more often" [25].

During the last decade, the scientific
evidence in the research of fluid intake
and hydration assessment increased.
More intake data on specifically fluid
intake were published, and the science
on hydration biomarkers also started
covering the general population. That
set the basis for more robust reference
values on total water intake in the future.
Ideally, because estimating the amount
of food moisture might be difficult for
the general population, these values will
be translated into recommendation on
the amount to drink, as well as on the
fluid types to drink. Moreover, given
the fact that a relative large proportion
of individuals don’t meet the reference
values and/or have a relatively high
intake of sugar-sweetened beverages,
national campaigns promoting the intake
of water seem pertinent.
Roselyne Y.
Wagner, PhD, is
a scientific project
manager for
PMCONSEILS in
France.
Isabelle Guelinckx,
PhD, is a fluid
intake manager in
the Hydration &
Health Department,
Danone Nutricia
Research in Palaiseau, France.

This article represents Part I of a two-part series. It explores the
scientific studies that demonstrate the value of drinking water
to optimize mood and cognitive processes. Part II, which will be
published in the March/April 2017 issue of Bottled Water Reporter,
will explore recent studies that link low daily water intake to a number
of chronic diseases and will provide simple recommendations to
help you maintain an optimal level of hydration.
Most adults recognize that water is essential to
health because it supports numerous physiological functions, including vision, circulation,
metabolism, excretion of waste products, and
regulation of body temperature. However, few
people are aware of recent research that has
discovered interesting and valuable cognitive
benefits of consuming water each day.

water loss in these studies is approximately
1.0-1.5 percent of body weight, which is considered a mild level of dehydration. Studies
comparing these dehydrated participants to
a group of control subjects (who consumed
as much water as they desired, and whenever
they desired it, ad libitum) have revealed
several interesting effects.

Scientists who study the effects of daily
water intake on the human body asked test
participants to stop drinking for half a day or
longer, then observed the detrimental effects
of the resulting dehydration. The amount of

Most adults rarely experience dehydration
greater than 3 percent during their daily
activities. The sensation of thirst and the
finely-tuned actions of the kidneys maintain
adult body weight within 1 lb (0.7%), from

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Mood & Mental Tasks

Most adults rarely experience
dehydration greater than 3 percent
during their daily activities. However,
even mild dehydration—that is,
1-2%—can affect mood, energy
level, and mental awareness.
one day to the next. However, it is likely
that most adults experience a 1-2%
body weight deficit several times each
week because thirst is not sensed until
we reach a 1-2% body weight loss.
Therefore, this article focuses on mild
dehydration (1-2% loss of weight).

Controlled Laboratory Studies
A Connecticut research team has
published the findings of two mild
dehydration studies (Ganio et al.,
2011; Armstrong et al., 2012). The
first involved a 12-hour body weight
loss of 1.4% in young women and the
second, 1.6% in young men. At those
levels of mild dehydration, both groups
experienced decreases on mental tasks,
compared to control days when they
were normally hydrated. Women
reported headaches, increased task
difficulty, and loss of concentration
when mildly dehydrated; they also
experienced mood changes in the
form of reduced vigor and increased
fatigue. Men similarly reported
increased fatigue, plus greater anxiety.
However, only men experienced poorer
performance on computerized mental
tasks, during vigilance and visual
memory tasks.
One year later, a French research group
studied the effects of 24-hour fluid
deprivation (FD) versus normal fluid
intake, on selected mood and physiological factors (Pross et al., 2013). The

participating 20 healthy young women normally consumed 2.0–2.8 liters
per day (L/d) of water. FD resulted in
increased sleepiness and fatigue, lower
levels of vigor and alertness, with
increased confusion. These women
also were more confused, less calm,
and less happy. Interestingly, these
mood changes were time-dependent,
with greater impairments during the
early afternoon (2:00 – 4:00 p.m.).
This well-controlled investigation
confirmed the findings of their initial
study involving mild dehydration,
which was published one year earlier
(Pross, 2012).
Modifying the amount of fluid consumed
each day also can alter mood. Pross and
colleagues (Pross et al., 2014) evaluated
52 women and men who habitually drank
either a low volume (LOW = 1.5 L/d)
or a high volume (HIGH = 2.7 L/d).
During three controlled drinking days, the
water intake of the 22 participants in the
HIGH group was restricted to 1 L/day,
whereas the water intake of the 30 LOW
group participants was increased to
2.5 L/day. No purposeful dehydration was
involved. In the HIGH group, the smaller
volume of water resulted in statistically
significant decreases of contentedness,
calmness, positive emotions, and vigor.
In the LOW group, drinking more water
resulted in decreased fatigue, confusion/
bewilderment, and thirst, with a
tendency toward less sleepiness.

A 2013 research investigation discovered the effects of drinking water on the
reaction time required to perform a simple fine motor task: pushing a button.
(Edmonds et al., 2013). Thirty-eight
test participants abstained from drinking any fluid overnight; this resulted
in a state of mild dehydration. In the
morning, one-half were not given water
to drink, and the other half consumed
up to 1 L of bottled water, as dictated
by thirst. The group that consumed no
water had a slower reaction time than
the group that drank water. The authors
proposed that water consumption
released mental resources (i.e., focused
attention) that were otherwise occupied
with brain processing of the sensations
associated with dry mouth and thirst.
Complex tasks also may be negatively
influenced by dehydration, as shown in
a 2015 study conducted in the United
Kingdom (Watson et al., 2015). The aim
of this study was to measure the effect
of mild dehydration on performance
during a prolonged, monotonous driving
simulation task. This task consisted of a
2-hour continuous drive in an immobile
car with a full-size, interactive, computergenerated road projection of a dull,
monotonous four-lane dual highway.
The computer screen “road” also had a
hard shoulder and simulated auditory
“rumble strips” (which were incorporated
into white lane markings on either side
of the highway and a barrier separating
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A U.K. study illustrated that mild
dehydration affects the body similarly
to sleep deprivation or a blood alcohol
level of approximately 0.08%.
the lanes), with long, straight sections
followed by gradual bends. Drivers were
instructed to remain within their lane
unless overtaking slow moving vehicles.
During the normal hydration experiment,
volunteers were provided with 200 mL
of fluid every hour, whereas only 25 mL
was made available each hour during the
fluid restriction experiment (FR); thus,
test subjects lost 1.1 percent of their body
weight during FR (mild dehydration).
The magnitude of performance decrement
during FR was similar to that observed
following sleep deprivation, or the
consumption of alcohol resulting in a blood
alcohol content of approximately 0.08%
(the current UK legal driving limit).
A different experimental approach was
taken by a group of investigators in the
United States, who observed 120 healthy
college-aged women during their normal
daily activities (Munoz et al., 2015).
These women drank water in volumes
that ranged from less than 1.0 L/d to
over 4.5 L/d, as shown in the figure at
right.They were subsequently divided
into three groups, to allow comparisons
to be made: LOW volume (average,
1.5 L/d), MOD volume (2.3 L/d), and
HIGH volume (3.1 L/d). Habitual total
water intake (foods + fluids) during
daily activities distinguished HIGH
volume drinkers from the LOW and
MOD groups. The entering, baseline
mood scores of these women was assessed with the Profile of Mood States
Questionnaire, which is widely accepted
in psychological research and is sensitive
to numerous stressors, including water
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restriction. Those who habitually consumed less water each day (see red line in
the figure below) reported more tension,
depression, confusion, and total mood
disturbance (a summary score).

Practical Applications
Since 2011, multiple randomized
controlled research studies have identified
the value of drinking adequate water
to optimize mood, vigor, vigilance,
visual memory, complex mental task
performance, and fine motor reaction
time; this included reducing the incidence
of headache. However, it is important

to place in perspective the level of
dehydration which these studies involved.
All of the above experiments were
conducted either in controlled laboratory
settings or while healthy men and women
went about their usual daily activities (i.e.,
no planned strenuous exercise sessions).
When fluid was withheld, body weight
loss in all studies reached 1-2%, a mild
level of dehydration. Because humans do
not perceive this level of mild dehydration
until they become thirsty (i.e., at 1-2%
body weight loss), it is likely that you
reach this level of dehydration several
times each week, without realizing it.

Daily Water Intake of 120 young women
20

Low
Drinkers

15

# of
Women

Average
Intake:
2.3 liters
(2.4 quarts)

10

5

0
0.00

1.00

2.00

3.00

4.00

5.00

Water Consumed in All Fluids and Foods (L/24h)

Mood & Mental Tasks

If your goal is to optimize your mood,
mental tasks, and processing of
information, recent hydration studies
provide sound evidence for optimizing
your daily water intake.
Therefore, if your goal is to optimize
your mood, mental tasks, and processing of information, the aforementioned
studies provide sound evidence for
optimizing your daily water intake. To
reach a minimum of 2.0 liters of total
water each day (water + beverages +
water in solid foods), remember that
22% of your total daily water intake is
consumed as water in solid food; thus,
you should drink at least 1.6 L of fluid,
in the form of water and beverages.
Indeed, the average volume of fluids
consumed by Americans (plain water
+ moisture in beverages) is 2.7 L/d
(men) and 2.2 L/d (women) (Yang &
Chun, 2016).

Lawrence E.
Armstrong, PhD,
is a professor of
Environmental &
Exercise Physiology
at the University
of Connecticut and
the director of the Human Performance
Laboratory. He presently serves as a
trustee of the Drinking Water Research
Foundation and as a scientific advisory
board member for Danone Waters, France.

Part II of this series will be published
in the March/April 2017 issue of
Bottled Water Reporter and will
describe how you can check your own
hydration status each day, by making
a few simple observations.

the news a lot recently: healthy hydration
and tap water safety are popular topics.
Water is the business of IBWA members—and, in a sense, it’s also the business
of the National Drinking Water Alliance
(NDWA). A network of organizations
and individuals, NDWA is working to
ensure that all children in the United
States can drink safe water in the places
where they live, learn, and play. NDWA
is proud to have the International Bottled
Water Association as an active ally.

water researchers and advocates with
stakeholders from industry, government
agencies, and professional organizations,
including IBWA. During the convening,
a consensus developed for a coordinated
network that, working together with
a shared mission, would leverage our
independent efforts and, thereby, most
effectively increase drinking water
consumption. Participants agreed that
we would focus on children and that the
Alliance would promote water “in all its
forms”: tap, filtered, and bottled.

NDWA grew out of a national
convening, hosted by the Nutrition
Policy Institute of the University of
California, Division of Agriculture
and Natural Resources, in 2015. The
meeting brought together drinking

Since then, NDWA has grown to
include a wide range of allies across the
United States. NDWA is now a collective impact-type effort coordinated by the
Nutrition Policy Institute at the University
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the W.K. Kellogg Foundation, which, as
described on its website (www.wkkf.org)
“works with communities to create
conditions for vulnerable children so
they can realize their full potential in
school, work, and life.”
NDWA allies work through four
primary levers—research, policy and
advocacy, access, and education and
promotion—to build tap water safety
and promote consumption of drinking
water. Below is a brief status report on
drinking water safety, access and promotion, and some of NDWA's activities.

Ensuring and Assuring Tap
Water Safety
Most tap water in the United States is
safe to drink. However, whether from

source water contamination or from
lead and copper that can leach into
water as it travels from municipal pipes
to building taps, there are pockets
throughout the United States where
tap water may be unsafe. And children’s
small bodies are more vulnerable to
even small doses of contamination. The
NDWA website offers an interactive
map where you can view media reports
of tap water contamination: www.drinkingwateralliance.org/map.
NDWA allies are among those working
at the federal, state, and local levels to
ensure tap water safety. Our efforts are
paying off in heightened awareness of
the need for testing water at the tap and
infrastructure improvements. In 2016,
we saw the following developments:

provides funds for a grant program to
improve access to safe water in schools.
•

Massachusetts earmarked $2.5 million for testing at the tap in schools.

•

Oregon’s State Board of Education
and Department of Public Health
require schools to develop Healthy
and Safe Schools Plans. Schools are
not required by law to test for lead
but they are required to report how
they are preventing lead exposure.

•

•

New York State became the first in
the nation to legislate required testing
at the tap in all public schools; testing
is already underway.
Rhode Island passed legislation requiring testing at the tap for lead in all
public schools and all licensed childcare facilities, public clinics, shelters,
foster homes, and treatment centers.

•

Thirty-eight federal bills were introduced that relate to lead in tap water.

•

A U.S. Department of Agriculture
(USDA) memo called for all regional
offices and state agencies to ensure that
children in National School Lunch Program (NSLP) schools and Child and
Adult Care Food Program (CACFP)
child-care homes and centers have access
to safe drinking water at no charge. (To
read that memo, visit: www.drinkingwateralliance.org/single-post/2016/07/22/
USDA-memo-issued-to-schools-regardingtap-water-safety.)

Following the American Academy of
Pediatrics, Prevention of Childhood
Lead Toxicity, recommendation that
lead testing resulting in a reading of
more than 1 part per billion (ppb)
should be immediately remediated,
the District of Columbia Department
of General Services will move to incorporate a 1 ppb action level for lead
tests on drinking water sources in
District of Columbia Public Schools
(DCPS) and Department of Parks
and Recreation (DPR) centers

California Governor Jerry Brown (D)
instructed the State Water Resource
Control Board to develop a permit
amendment requiring all community
water systems to offer free testing for
lead and copper in every school served
by each system. Testing is anticipated to
begin in 2017. The state’s budget also

Those efforts not only help to identify
unsafe water conditions but also include
requirements that schools clearly communicate the safety of their facility’s
water to the families they serve. NDWA
believes safety goes both ways: ensuring
that water in the places where children
spend their time is safe (through testing

•

NDWA

NDWA works to ensure that all
children in the United States can
drink safe water in the places where
they live, learn, and play.

•

More About NDWA
NDWA offers its allies and the
public many great resources,
including the following:
• serves as a clearinghouse for
resources and toolkits for improving drinking water access
and providing drinking water
education and promotion
• maintains an updated bibliography of the peer-reviewed
research on drinking water
access and consumption
(www.drinkingwateralliance.
org/research)
• tracks legislation, educates
decision makers, works to put
Water in All Policies
• connects partners across
sectors and geographies to
work together to make water
“First for Thirst.”
To learn more about NDWA,
visit DrinkingWaterAlliance.org.

at the tap and remediation), and assuring
the public (through publicizing testing
results) that we know where the problems are and that, in the vast majority of
places, tap water is safe.

How Might This
Impact IBWA?
Schools with unsafe tap water may
need to provide students with bottled
water at no charge to meet the water
provisions in the Healthy, HungerFree Kids Act of 2010 (HHFKA,
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The Flint Effect
Marc Edwards, PhD—who is professor of civil and
environmental engineering at Virginia Tech and
a recipient of the MacArthur Grant (commonly
referred to as the “Genius Grant”)—presented
the Drinking Water Research Foundation’s
(DWRF) Alan A. Leff Memorial Lecture during
the 2016 IBWA Annual Business Conference,
held November 7-11 in Nashville, Tennessee.
Dr. Edwards’ presentation, “Understanding the Flint, MI Water Crisis,” not
only chronicled discovering and bringing to the public’s attention the high
lead levels and legionella issues that were uncovered in Flint but also earlier
findings from 2001 of high lead in drinking water in Washington, DC.
In Flint, Dr. Edwards led a research team that collaborated with local
residents and government officials to address lead, pathogen, and water
infrastructure issues caused by a failure to implement corrosion control
treatment in the public water system. He summarized the Flint water
study team’s efforts, which combined ethics, engineering, citizen science,
laboratory experiments, investigative science, and social media, to
confirm the high lead levels in Flint’s public water system. The Edwardsled Flint Water Study Team received Virginia Tech’s Alumni Award for
Outreach Excellence 2016, and Dr. Edwards was recognized by Fortune
and Time magazine as one of the most influential people in 2016.
Dr. Edwards’ presentation will be posted on the DWRF website
(www.thefactsaboutwater.org) and YouTube in the near future.

child nutrition reauthorization)
unless or until the schools mitigate
maximum contaminant levels of lead
in their tap water through filtration
or longer term strategies.
IBWA supports federal legislation that
would establish a $475,000 grant program
to help states provide bottled water to
schools and child-care facilities when they
are faced with contaminated water supplies.
This grant program would be administered
by the USDA, and the funds would be
available when the president has declared
a state of emergency and it is determined
that the public water system poses a significant risk to the health of school children.
(Unfortunately, the bill did not pass out of
Congress in 2016.)

Access to Drinking Water:
Making the Healthy Choice
the Easy Choice
Too often children lack what we call
“effective” access to water: there may
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be too few water fountains at school,
or they are broken or dirty (or simply
unappealing), leading children to be
under-hydrated during the school day.
NDWA works to provide evidencebased best practices to build effective
access to water in schools and child
care, supporting the HHFKA which
requires access to potable water at no
charge in schools operating the NSLP
and all CACFP sites. For more, visit
www.drinkingwateralliance.org/access.
Sometimes there is confusion about
beverages in the NSLP school meal programs. Milk must be offered in the cafeteria service line; in many schools and
almost all high schools, meals are “offer
vs. serve.” Children are required to take at
least three out of five reimbursable lunch
items to make a complete meal. This is
necessary for the school to receive NSLP
reimbursement from the USDA. Milk
is one of those five items that must be
offered and is one of the items students

usually select. Water may not be offered
in the service line in place of milk. Water
is required to be available, at no charge, in
the cafeteria or eating area.
NDWA allies currently have several
research projects underway on drinking
water access in schools, including the
following:
•

an in-depth look at drinking water
access in Seattle-area high schools,
funded by Healthy Eating Research
(HER), a national program of the
Robert Wood Johnson Foundation—
the nation’s largest philanthropy
foundation dedicated solely to health

•

development of a “photo-evidence”
tool to assess quality of water access
in schools, funded by HER.

NDWA also currently has an active
campaign working to ensure water
access in schools. The Healthy, HungerFree Kids Act requires that all schools
operating on NSLP also develop a “Local
School Wellness Policy.” Those policies
must be in place by summer of 2017,
and a number of advocacy organizations
have been working to inform schools
about the requirement and to provide
model language. NDWA has helped to
promote this campaign and to disseminate model Wellness Policy language for
bringing effective access to safe drinking water into schools. For more, visit
NDWA’s Take Action campaign: www.
drinkingwateralliance.org/actionschools.

What About Bottled Water
Sales in Schools?
The new USDA guidelines for sales
of “competitive foods” (i.e., foods sold
à la carte in schools), called the Smart
Snacks guidelines, are now effective in
all schools on NSLP. These guidelines
prohibit sales of most sugar-sweetened
beverages in schools, opening up space
in vending machines for plain bottled
water. For more information, visit www.
fns.usda.gov/healthierschoolday/toolsschools-focusing-smart-snacks.

NDWA

Like IBWA, NDWA has been advocating for the USDA to add a symbol for water to the MyPlate nutrition guide.

Drinking Water Promotion:
“Water: First for Thirst”
Myriad efforts are underway across
the United States to promote water
consumption. NDWA wants young
families to know that, once infants are
ready for the introduction of complementary foods, water is the best choice
for a secondary beverage after breast
milk or infant formula. With expert
panels working to develop recommendations for infant nutrition and feeding
practices (and the 2020-2025 Dietary
Guidelines for Americans revision
expected to expand to include infants
and toddlers, from birth to age 2), it is
timely to begin to educate and promote
healthy hydration from the early years.
The New York City Department of
Health just released a series of videos that
capture, in children’s own words, why they
drink water. In a collaboration between researchers and film-makers, the University
of California, San Francisco, developed
short videos in English and Spanish
entitled “Share the Love, Share the Water.”
In addition, First 5 Santa Clara, out of
California, has created “Potter the Otter,”
a popular character used in child-care
facilities and schools to teach and remind
children to drink water. Potter the Otter
demonstrates healthy behaviors and serves
as a visual reminder for young children

to drink water. Potter the Otter and
other such visual cues will be even more
important by October 1, 2017, when
child-care sites operating on CACFP
will be required not only to make water
available throughout the day (the current
requirement) but also actively to offer it to
children regularly, preferably with a visual
cue at the same time.

4,000 sticky pads have been distributed
by WIC clinics, child-care sites, the
American Federation of Teachers, educators, researchers, and advocates, letting
nutrition educators across the country
add their own symbol for water to the
MyPlate graphic. These and other promotional resources are available at www.
drinkingwateralliance.org/education.

Those efforts, and many other community
campaigns, are promoting water as the best
replacement for sugar-sweetened beverages.

NDWA looks forward to continuing
to work with IBWA to advocate for a
symbol for water on MyPlate!

IBWA and NDWA:
A Great Team

Christina Hecht,
PhD, is a senior
policy advisor at
the University
of California
Nutrition Policy
Institute (npi.
ucanr.edu), which formed the National
Drinking Water Alliance in 2015
(www.drinkingwateralliance.org). Her
primary focus area is healthy beverages,
particularly drinking water, the healthy
alternative to sugar-sweetened beverages.
She studies drinking water access and
consumption, particularly in children,
and works with colleagues across the
country to promote and advocate for
drinking water access and to reduce
disparity in access to and consumption
of healthy beverages.

Researchers and public health advocates
across the country, together with IBWA,
have been advocating for the USDA to
take the necessary steps to add a symbol
for water to the MyPlate nutrition
graphic. The 2015-2020 Dietary Guidelines for Americans stressed the importance of reducing consumption of added
sugars and suggested that water was an
ideal replacement for sugar-sweetened
beverages. Water is an essential part of
a healthy diet, and NDWA and IBWA
believe the nation’s most ubiquitous
nutrition guidance should reflect that.
As part of the campaign, NDWA developed a graphic (top-left of page) to print
on sticky pads. To date, approximately

JAN/FEB 2017

BWR

27

Making the Political Argument
for Health Hydration

By J.P. Toner, IBWA Director of Government Relations

During a typical meeting with elected
officials and other key decision
makers at the national, state, and
local levels, it is increasingly difficult
to find an opportunity to talk
about one of bottled water’s most
important positive attributes: healthy
hydration. The reason is because
other issues—such as recycling, water
28

BWR

WWW.BOTTLEDWATER.ORG

use, bisphenol A (BPA), taxes, and
adequate funding for the U.S. Food
and Drug Administration (FDA)—
tend to dominate the discussions. So,
how does one work into high-level
conversations the benefits of drinking
water and the important role bottled
water plays in helping Americans
become healthier?

Make Health a Priority
Most legislators are concerned, on some
level, about fiscal matters. No matter the level of government, liberal or
conservative, urban or rural, lawmakers
are always looking for opportunities to
preach about the evils of bloated budgets, crushing deficits, and their impact

GOVERNMENT RELATIONS
on average citizens. And it’s no secret
that some lawmakers and regulators
want to focus on issues that grab headlines. But even beyond that, lawmakers love to provide their constituents
(and the media) examples of how they
helped save their communities.
Here’s a conversation-starter for
bottled water professionals. The cost
of health care in the United States
is staggering. Whether reporting on
Obamacare or Medicaid, the media
hardly lets a day go by without covering
the overwhelming burden on the U.S.
health-care system—and the health
crisis in America. But, bottled water can
help Americans become healthier, which
means we have an amazing opportunity
to chime in on health-care discussions
with facts about the benefits of water
consumption. Recent, important scientific
research has shown how the simplest of
changes in the average diet—switching
from sugar-sweetened beverages to
water—can reap huge benefits. It’s vital for
bottled water professionals to relate such
facts to our lawmakers.

The Swap and Flip
Swapping out sugar-sweetened beverages
(e.g., soda and juice) with bottled water
is a healthy eating decision that can lead
to better overall health and weight loss.
With the obesity epidemic in America
hobbling the U.S. health-care system,
the positive results of drinking more
water should not be minimalized. It’s
our job to educate legislators and help
them understand how adequate water
consumption promotes overall health.
We have access to research that’s sure
to get the attention of those making
important decisions about the future of
health care in the United States.
In fact, legislation is being introduced to
help steer people toward making healthier
beverage choices. At the local level,
there are efforts to tax sugar-sweetened
beverages. For example, in Berkeley,
California, a sugar-sweetened beverage

tax not only showed a 21 percent drop in
the consumption of beverages with added
sugar but also a 63 percent increase in
the consumption of bottled or tap water.
This is a great example of the importance
of keeping access to water, in all forms,
available to consumers.

Dr. Armstrong’s research received
national coverage in Fitness Magazine
and on MensHealth.com. (Learn more
by reading Dr. Armstrong’s article on
p.20 in this issue of BWR: “Drink
More Water Each Day to Optimize
Mood and Mental Tasks.”)

EDUCATING LEGISLATORS ON
HEALTHY HYDRATION IS OUR JOB.
When broaching the topic of healthy
hydration with lawmakers, you may
find that they would rather talk about
groundwater use or waste management.
While those are obviously important
issues to discuss, if you want to flip the
conversation to healthy hydration, ask
if they’ve heard about the U.S. Department of Agriculture’s (USDA) latest
tweaks to the MyPlateMyWins print
materials. (Check them out at bit.ly/
MyPlateMyHydrationWins.) One new
recommendation states, “Drink water
instead of sugary drinks.” You could
note that when national organizations
such as USDA, FDA, and the Department of Health and Human Services
(HHS) promote healthier eating habits
for Americans, they all agree on the
benefits of water consumption.
It’s important to relate that, in
addition to the physical improvements
that regular consumption of water can
effect, there are mental benefits too. The
research of Lawrence E. Armstrong,
PhD, a professor at the University
of Connecticut and trustee of the
Drinking Water Research Foundation
(DWRF), has shown the unique
connection between proper hydration
and cognitive performance. His data
demonstrates how staying regularly
and properly hydrated during the day
can help people feel less fatigued, less
confused, and overall in a better mood.

Lastly, a great way to show the
bottled water industry’s support for
any and all efforts to promote the
consumption of water—whether
filtered, bottled, or tap—is IBWA’s
involvement with Drink Up (youarewhatyoudrink.org.) This campaign,
created by the Partnership for a
Healthier America (which works with
stakeholders across the public and private sectors) and has Michelle Obama
as its honorary chair, is dedicated to
encouraging people to “drink more
water more often.” That’s a message I
think we all can get behind.

MEET YOUR
LEGISLATORS
The political landscape will be
different in 2017, so it is more
important than ever for IBWA
members get to know their
elected officials and educate
them about bottled water issues. Visit bottledwatermatters.
org and click the "Take Action"
tab to learn the names of your
current federal, state, and local
legislators. Then, take a moment
to contact them and let them
know you work in their district
and you'd like to talk with them
about bottled water.

JAN/FEB 2017

BWR

29

Bottled Water’s Popularity
Tells an Important—and
Healthy—Story
By Chris Hogan, former IBWA Vice President of Communications

As you’ve probably heard, bottled water
is about to mark a historic milestone:
according to Beverage Marketing
Corporation (BMC), bottled water
will overtake carbonated soft drinks as
America’s largest beverage category, by
volume, by early 2017. Consumption of
bottled water increased by 7.8 percent
in 2016, and bottled water sales were up
an impressive 8.6 percent, now totaling
$15.8 billion (wholesale). This isn’t a
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WWW.BOTTLEDWATER.ORG

fluke. For decades, consumers have been
increasing their bottled water consumption. Here’s some context: in 2005, every American was drinking, on average,
25.4 gallons of bottled water. However,
by 2016, that figure had jumped to 39
gallons, an increase of 13.6 gallons.
BMC predicts that demand for
bottled water will remain strong in
the coming years—and soft drink
consumption will continue to wane.

This kind of cultural shift in consumer
preference reflects a clear trend of
consumers increasingly choosing
healthy, convenient, zero-calorie bottled
water as their on-the-go beverage.

Beverage of Choice
This consumer shift isn’t really surprising. Most of what we drink today
comes in a package, and a vast majority

COMMUNICATIONS
of consumers see bottled water as a
smart beverage choice for when they are
thirsty for something healthier than a
soft drink. According to a 2015 Harris
Poll survey conducted for IBWA, 96
percent of Americans believe that we
should be drinking more water. The
poll also found that 95 percent of
Americans believe that bottled water
is a healthier beverage choice than soft
drinks, and 92 percent say bottled water
should be available wherever other
beverages are sold.
Americans backed up those statistics
with their wallets, choosing bottled
water as the clear winner when selecting a beverage packaged in plastic. Of
course, from a business perspective,
the industry benefits—increasing sales
and record consumption is certainly
good news. However, the fact that this
shift is consumer-driven is the real
news. Make no mistake, while IBWA
continues to educate people about
other important issues—such as our
industry’s long history of environmental stewardship, the need for increased
recycling, and the safety of bisphenol
A (BPA)—choosing water for healthy
hydration is already a reflexive action
for growing numbers of Americans.

Convenient and Healthful
Consumers value bottled water for
many reasons. Its versatility makes
bottled water a great choice for
consumption any time of day and in
just about any setting. It doesn’t need
to be kept ice cold (like soft drinks
or juice) or warm (like conventional
coffee or tea). Also appealing are the
various packaging types offered—with
bottled water available not only in
3- and 5-gallon bottles used in homes
and offices but also various single-serve
container sizes sold at retail locations.
According to “Modeling the Effect of
Replacing Sugar-Sweetened Beverage
Consumption with Water on Energy

Intake, HBI Score, and Obesity
Prevalence,” a recent study funded by the
Drinking Water Research Foundation
(DWRF) and published in the peerreviewed journal Nutrients, losing weight
and improving risk factors for chronic
diseases may be as easy as drinking a

during emergencies, natural disasters,
and other catastrophic events. The lead
contamination of Flint, Michigan’s tap
water and concerns about public water
system problems in other U.S. cities,
underscore the importance of having
access to safe, drinkable water.

CONSUMERS INCREASINGLY
CHOOSE BOTTLED WATER AS
THEIR ON-THE-GO BEVERAGE.
glass of water instead of a soft drink or
other sweetened beverage. Using national
nutrition surveillance data, study results
found that swapping water for 8 ounces
of sweetened beverage every day could
save people roughly 100 calories, which
is between 15 and 30 percent of adults’
total caloric intake. In fact, results also
revealed that 18 percent of calories
in adults’ diets come from beverages.
Current public health recommendations
limit beverage calories to less than 15
percent of total daily calories.

The State of Things
Bottled water companies are proud to
play a role in helping consumers achieve
a healthier lifestyle, but, sometimes,
they play an even more important role:
provider of life-saving, safe drinking
water when public water systems are
compromised. Our industry has always
been at the forefront of relief efforts

The bottled water industry has long
supported strong, reliable, public water
systems. But, when clean tap water is
unavailable, the bottled water industry has
been, and will always be, there to ensure
that people have access to safe, quality, water. Throughout the years, bottled water
companies have immediately responded
to the need for clean water after disasters,
such as hurricanes, earthquakes, tornados,
wildfires, and flooding. But, what is not
often understood is that, in order to respond so rapidly, bottled water companies
must be part of an active, viable industry.
The fact remains that the bottled
water industry has a great story tell.
As we prepare for bottled water’s
ascendency to the top of America’s
beverage preference list, we should bear
in mind that in many ways this landmark
moment is actually just a new chapter in
the exciting history of bottled water.

IBWA WEB POSTERS
AVAILABLE
Looking for content for your social media
platforms? Visit www.bottledwater.org/
bottled-water-visuals and download
educational posters you can share with
your followers to help them learn about
healthy hydration.

“Mitigation Strategies to Protect Food
Against Intentional Adulteration,” also
known as the Intentional Adulteration
Rule (“IA Rule”), was published by the
U.S. Food and Drug Administration
(FDA) as a final rule on May 27, 2016.
IBWA initiated an assessment of the
rule to determine its impact on members
of the association. Staff quickly found
a surprise, and our first thoughts were
that FDA had made an error in applying
the rule. As you know, IBWA’s Bottled
Water Code of Practice has required
member bottling facilities to develop and
maintain a food defense plan since 2004.
The exemptions in the final rule based
on company size triggered a reassessment
of that policy by the IBWA Technical
Committee and Board of Directors.
32

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WWW.BOTTLEDWATER.ORG

Overview of the Final Rule
The FDA Food Safety Modernization
Act (FSMA) final rule is aimed at
preventing intentional adulteration from
acts intended to cause wide-scale harm to
public health, including acts of terrorism
targeting the food supply. Such acts, while
not likely to occur, could cause illness,
death, and economic disruption of the
food supply absent mitigation strategies.
Rather than targeting specific foods or
hazards, this rule requires mitigation
(risk-reducing) strategies for processes in
certain registered food facilities.

Key Provisions of the Rule
FDA has taken an approach similar
to the Hazard Analysis Critical

Control Point (HACCP) system, a
process adopted by industry for the
identification, evaluation, and control
of food safety hazards. Each covered
facility is required to prepare and
implement a food defense plan. This
written plan must identify vulnerabilities
and actionable process steps, mitigation
strategies, and procedures for food
defense monitoring, corrective actions,
and verification. A reanalysis is required
every three years or when certain
criteria are met, including mitigation
strategies that are determined to be
improperly implemented.
The rule and the food defense plan
include the following components:
Vulnerability assessment. This is
the identification of vulnerabilities

TECHNICAL UPDATE
and actionable process steps for each
type of food manufactured, processed,
packed, or held at the food facility. For
each point, step, or procedure in the facility’s process, the following elements
must be evaluated:
• The severity and scale of the
potential impact on public
health. This would include such
considerations as the volume of
product, the number of servings, the
number of exposures, how fast the
food moves through the distribution
system, potential agents of concern,
and the infectious/lethal dose of
each—and the possible number of
illnesses and deaths.
• The degree of physical access to the
product. Things to be considered
would include the presence of such
physical barriers as gates, railings,
doors, lids, seals, and shields.
• The ability to successfully
contaminate the product.
Mitigation strategies. These should
be identified and implemented at each
actionable process step to provide
assurances that vulnerabilities will be
minimized or prevented. The mitigation
strategies must be tailored to the facility
and its procedures.
Mitigation strategy management
components. Steps must be taken to
ensure the proper implementation of
each mitigation strategy. In each of
these areas of food defense, the facilities
are given more flexibility in the final rule
to establish the actions most appropriate to their operation and product.
• Monitoring: establishing and
implementing procedures, including
the frequency with which they are
to be performed, for monitoring the
mitigation strategies.
• Corrective actions: the response if
mitigation strategies are not properly
implemented.
• Verification: verification activities
would ensure that monitoring is being

THE IA RULE IS AIMED AT
PREVENTING ACTS OF
INTENTIONAL ADULTERATION.
conducted and appropriate decisions
about corrective actions are being made.
Training and recordkeeping.
Facilities must ensure that personnel
assigned to the vulnerable areas receive
appropriate training, and facilities
must maintain records for food defense
monitoring, corrective actions, and
verification activities.

are required to comply four (4) years
after the publication of the final rule.
Other Businesses. Businesses that
are not small or very small do not qualify for exemptions. These businesses are
required to comply three years after the
publication of the final rule.
IBWA will continue to monitor
implementation of the IA Rule over the
next two-three years.

Compliance Dates
FDA is providing the following longer
timelines for facilities to comply with
the intentional adulteration rule.
Very small businesses. Businesses
(including any subsidiaries and
affiliates) averaging less than
$10,000,000, adjusted for inflation,
per year, during the three-year period
preceding the applicable calendar
year in sales of human food plus
the market value of human food
manufactured, processed, packed, or
held without sale (e.g., held for a fee)
are considered very small businesses.
This exempts the majority of IBWA
member bottling facilities from
complying with almost all of the
rule’s provisions, which lead IBWA to
reevaluate its long-standing policy on
food defense.
Very small businesses are required
to comply with modified requirements
within five years after the publication of
the final rule (i.e., a very small business
must, upon request, provide for official
review documentation sufficient to show
that the facility meets this exemption).
Such documentation must be retained
for two (2) years.
Small businesses. If your company
employs fewer than 500 persons, you

IBWA'S 2017 PCQI
WORKSHOPS
IBWA is currently planning its
2017 PCQI workshop schedule,
focusing on the following cities:
• Orlando, Florida:
February 2017
• Dallas/Fort Worth, Texas:
March 2017
• Charlotte, North Carolina:
April 2017
• Albany/Troy, New York:
April/May 2017
• Sacramento, California:
May 2017
• Denver, Colorado:
May 2017
• South Bend, Indiana:
July 2017
All dates are tentative until a
hotel has been contracted. As
additional information becomes
available, IBWA members will
be updated via the News Splash
e-newsletter and special email
announcements. If you have any
questions, contact IBWA Vice
President of Education, Science,
and Technical Relations Bob Hirst:
bhirst@bottledwater.org.

According to the IBWA Code of Practice, water
intended for bottling shall not be stored, transported,
processed, or bottled through equipment or lines
used for milk, other dairy products, non-beverage
foods, or any non-food product.

OO True
OO False

5|

Determining the ability to successfully contaminate
the product is part of a _____.

OO
OO
OO
OO

34

BWR

FDA
DHS
OSHA
EPA

WWW.BOTTLEDWATER.ORG

6|

The term applied to a delayed health
hazard is _____.

OO
OO
OO
OO

Immediate
Long-term
Chronic
Acute

7|

The IA Rule defines a small business as a
business that _____.

OO
OO
OO
OO

Employs fewer than 500 people
Has annual sales of less than $2 million
Is owned by an individual
Produces less than 2,000 cases of water per day

8|

A bottled water plant shall be operated under the
supervision of a competent person qualified by
experience, education, and training to operate and
maintain the plant’s facilities.

OO True
OO False

9|

These should be identified and implemented at each
actionable process step to provide assurances that
vulnerabilities will be minimized or prevented. These
must also be tailored to the facility and its procedures.

WE'RE NO.1
IN 2017, BOTTLED
WATER WILL
SOFT DRINKS
OUTPACE
AS THE NO.
BEVERAGE
1
IN THE UNITED PACKAGED
STATES.
Now is the
time to ensure
your business
is a part of
that success—n
to plan your
ow is the time
advertising
campaign with
Internationa
l Bottled Water
the
Association
authoritative
, the
voice on all
issues concerning
the bottled
water industry.

JOIN OUR
TEA M

CSBWA 9th Annual Convention
and Trade Show
River City Hotel and Casino
St. Louis, MO

ARE YOU AN IBWA
PAC MEMBER?
The IBWA Political Action
Committee (PAC) is an important
and vital component of IBWA’s
political advocacy—both in
Washington, DC, and in your
backyard.
Interested in learning more about
the activities and work of the
IBWA PAC and how you can
support industry efforts?
Contact IBWA Director of
Government Relations
J.P. Toner: 703.647.4616 or
jtoner@bottledwater.org.

JAN/FEB 2017

BWR

35

Join Us In the Business of
Making the World Healthy!
Contact membership at 703-647-4615 or cbass@bottledwater.org if you have interest in joining!
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